Circulatory Changes Produced by the Valsalva Maneuver in Normal Subjects, Patients with Mitral Stenosis, and Autonomic Nervous System Alterations

The cardiac output has been measured during the immediate post-Valsalva maneuver recovery period in normal subjects, patients with clinically significant mitral stenosis, and patients with alterations of the autonomic nervous system. When compared with the resting value, it was found that normal subjects had a decrease in cardiac output during the immediate post-Valsalva recovery period, while patients with mitral stenosis had an increased output following the same stress. Three patients with alterations of the autonomic nervous system had a variable response. Changes in total peripheral vascular resistance usually were directionally opposite to changes in the cardiac output. The difficulties of attaching clinical significance to a patient's response to the Valsalva maneuver are considered.